[CIS PIDD] [cis-pidd] Persistently elevated anti-VCA (EBV) IgM

[Boyce, Thomas G., M.D.]

A small percentage of normal patients have persistently positive IgM antibodies after an episode of primary EBV infection.  I would stop checking it.


Thomas G. Boyce, MD, MPH
Pediatric Infectious Diseases and Immunology
Mayo Clinic
Rochester, MN 55905
phone: 507-255-8464
fax: 507-255-7767


From: Juan Carlos Aldave Becerra [mailto:jucapul_84 at hotmail.com]
Sent: Tuesday, June 30, 2015 7:10 PM
To: CIS-PIDD
Subject: [cis-pidd] Persistently elevated anti-VCA (EBV) IgM

Dear professors,

I would appreciate your expert opinions regarding the following case.
Today I evaluated a 8 year-old boy with elevated anti-VCA (EBV) IgM lasting almost 2 years.

I summarize his clinical history:
- Age: 8 years.
- No history of consanguinity.
- No severe infections, no candidiasis, no abscesses.
- October 2013: fever, lymphadenopathies, splenomegaly and leukocytosis with lymphocytosis. The clinical features resolved completely over 2 weeks without any complication or sequelae. At that time the only positive diagnostic result was an elevated anti-VCA IgM, which persists high for almost 2 years, as shown below:



16-Oct-13

11-Mar-14

13-Jun-14

14-Jul-14

13-Oct-14

29-Jan-15

Early Antigen Antibody

Negative

Negative

Negative

Negative

127.973

100.801

Anti-VCA IgM

248.7

225.6

141.727

106.039

112.309

140.059

Anti-VCA IgG

255.8

221.096

212.37

121.512

199.94

224.182

Anti-EBNA IgG

Negative

290.723

268.678

217.786

195.96

307.407


- EBV-PCR has not been performed (not available).
- IgG, IgA, IgM, liver function tests, B2-microglobulin: within normal values.
- Negative IgM to CMV and rubella.
- Positive IgG to CMV and rubella.
- WBC=10,940; lymphocytes=5,650; neutrophils=4,240; eosinophils=480; CD3+ cells=4,256; CD4=1,713; CD8=2,155; CD19=500/uL.
- Inverted CD4:CD8 ratio.
- Mild eosinophilia (between 480 and 1280 cells/uL).

The patient looks healthy, the mother denies any current symptom.

Please, I would appreciate your expert insights. My question is if the patient's serologic status can be "normal" or I should look for PIDs with susceptibility to EBV.

Thank you very much.

With my best regards,

Juan


Juan Carlos Aldave, MD
Allergy and Clinical Immunology
Edgardo Rebagliati Martins National Hospital
Lima, Peru


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